Joshua Montoya on his 5th birthday with his Children’s Hospital Colorado Heart Institute doctors, Scott Auerbach and Max Mitchell. Montoya was airlifted in November 2013 from Albuquerque, NM to Children’s Colorado, where he spent months in the hospital connected to a Berlin heart pump before receiving a heart transplant in mid-June. He just went home to New Mexico Sept. 16. The ACE Kids Act will help kids with complex medical needs, like Montoya’s, to cross state lines to access specialized care (Photo courtesy of Children’s Hospital Colorado).

Children prematurely born and those with cancer, congenital heart disease, cystic fibrosis, Down syndrome and other complicated medical conditions have lifelong challenges that proposed federal legislation would try to make more manageable for families.

About two-thirds of the 3 million U.S. children with complex cases are covered by Medicaid. They make up only 6 percent of Medicaid child enrollees, yet they account for almost 40 percent of Medicaid costs for children, said Children’s Hospital Colorado chief executive Jim Shmerling.

Advances in health care have made it possible for many more of these children to survive these conditions. Yet many must first go from doctor to doctor to find answers and effective treatments. They often must leave their home states to get the specialized care they require at regional centers.

The proposed Advancing Care for Exceptional Kids Act of 2014, or ACE Kids, would provide for the creation of voluntary nationally designated children’s hospital networks to coordinate care for children with complex illnesses and disorders. Based on health needs and family preference, each child would be matched with a network anchored by a children’s hospital — it would help both families and providers across state lines, proponents say.

“These children receive fragmented care from multiple providers and duplicated tests, Shmerling said. “It’s a very expensive fragmented system. We need to reshape the delivery of their care.”

Bill supporters, which began with 10 children’s hospitals and now includes more than 60 hospitals, point to two commissioned actuarial studies showing the coordinated system they propose could cut Medicaid costs by 2 percent, saving $10 billion to $13 billion a year.

“This is certainly not a grab for market share,” he said. “It improves care and reduces costs.”

The Troop family from Bountiful, Utah, has adopted six children. Four of them have a rare connective-tissue disorder called epidermolysis bullosa, or EB, with skin so fragile that almost any friction or impact can cause blisters, wounds and scarring. It’s the same with the mucosal tissue lining their mouths, throats, eyes and affects organs.

Children’s Hospital Colorado is seeing high numbers of respiratory illnesses. 9-year-old patient Jayden Broadway of Denver is being treated at the hospital on Monday, September 8, 2014 for the enterovirus 68. Broadway’s mother Melissa Lewis gives him a kiss after a coughing fit. Broadway’s asthma has made the illness more difficult to fight. A third of visits to the hospital’s emergency department have been for respiratory illnesses. (Denver Post Photo by Cyrus McCrimmon)

Every year, about two to four weeks after school start, a big spike in asthma-related hospital visits occurs among children with asthma that experts say is largely avoidable.

This year, the usual September spike in visits to emergency departments and hospital units by children in respiratory distress was up to 15 percent higher because of an outbreak of viral cases, Children’s Hospital Colorado physicians say.

Physicians don’t know why for certain, said Dr. Monica Federico, pediatric lung specialist and director of Children’s asthma program. They do think that many emergency or urgent cases could be avoided each year if asthma patients were more consistent in taking asthma-controlling medications.

“People who have asthma — sometimes you feel terrible and sometimes you feel fine. People, in the summer, feel so good they stop taking their meds,” Federico said. “There is data they don’t fill their medications.”

The presumption is that children reunited with their classmates in close quarters in classrooms are exposed to more germs and colds, which can trigger asthma attacks. Late-summer allergens, such as ragweed, might trigger asthma attacks, as about 80 percent to 90 percent of pediatric asthma is triggered by allergies, Federico said.

And, going back to school means parents aren’t around to keep a watchful eye on children’s use of their puffers – the dose-metered inhalers used to take asthma medicine, the corticosteroids that reduce the inflammation of airways.

Whatever the September triggers are, Federico said, more consistent use of controller medications could help families avoid many attacks, which are caused by inflammation, bronchospasms and excessive mucous in airways.

University of Florida study finds that surgery to repair aneurysms improves a stroke victim’s chances of surviving and fully recovering, yet Medicare patients are less likely to receive the surgical repair than those privately insured (Lindsay Pierce, YourHub).

Medicare patients might face a conscious or unconscious bias that could mean their stroke is more likely to end in death or long-term disability than patients with private insurance, according to a study announced Sept. 10 by the University of Florida.

Researchers found that Medicare patients are likely to have access to surgical treatment for a type of stroke, subarachnoid hemorrhage, that affects about 30,000 Americans a year. Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. It accounts for 5 percent of all strokes, according to the American Heart Association.

Surgical intervention can mean the difference between full recovery and disability, even death, the study authors said.

“Surgery is valuable — really, essential — if your’re going to have a good outcome,” said the study’s lead author, Dr. Charles Hobson.

Surgeries repair the source of the bleeding — an aneurysm, a localized weakness in a blood vessel wall that distends, becoming a blood-filled balloon-like bulge that eventually ruptures.

Medicare patients were almost 45 percent less likely to be operated on, and were more than twice as likely to die in the hospital, the study found.

Medicare patients are typically older and more likely to have health issues, disabilities or chronic illnesses, said senior author Dr. Azra Bihorac, an associate professor of medicine and surgery at UF College of Medicine.

“It’s not that you don’t get surgery because you have Medicare — your doctor isn’t checking your insurance,” Hobson said. “But having Medicare as a primary insurance may be a proxy for bias against the elderly and those with chronic illnesses.”

LITTLETON, CO – JUNE 10: Soaking up the sun at the swim beach at Chatfield State Park in Littleton. ( Photo by Helen H. ichardson/The Denver Post)

Americans can’t seem to take this seriously.

Even though there has been widespread education about sun safety, and skin cancer is mostly preventable, diagnoses and deaths continue to increase.

So much so, the Surgeon General recently outlined a national action plan to re-energize the fight against skin cancer.

Five million people are treated for skin cancer each year at a cost of $8 billion. Sun worshiping is a big public health problem.

So stop sunbathing. Use protection outdoors that include sunscreens, sunglasses and hats. Don’t use indoor tanning beds, the acting U.S. surgeon general, Adm. Boris Lushniak, warned in a report released in late July.

“The number of Americans who have had skin cancer at some point in the last three decades is estimated to be higher than the number for all other cancers combined, and skin cancer incidence rates have continued to increase in recent years,” the report states.

Lushniak cited a 200 percent jump in deadly melanoma cases since 1973. Melanoma is responsible for the most deaths of all skin cancers, he said, with nearly 9,000 people dying from it each year. About $3.3 billion of skin cancer treatment costs are attributable to melanoma.

He said state and local officials need to do more to help people shelter from the sun by providing more shade at parks and sporting events.

“The Call to Action focuses on reducing UV exposure, with an emphasis on addressing excessive, avoidable, or unnecessary UV exposures (such as prolonged sun exposure without adequate sun protection) and intentional exposure for the purpose of skin tanning (whether indoors using an artificial UV device or outdoors while sunbathing).”

This is a running blog on The Daily Dose listing the latest recalls of food, dietary supplements and other health or beauty products reported by the Colorado Department of Public Health and Environment. Check here for frequently updated recall news.

FDA analysis confirmed the presence of DMAA, which is 1,3-dimethylamylamine, also called methylhexanamine, or geranium extract.

DMAA is commonly used as a stimulant, pre-workout, and weight-loss ingredient in dietary supplement products. The FDA has warned that DMAA is potentially dangerous as it can narrow blood vessels and arteries, which can cause a rise in blood pressure or other cardiovascular problems, such as shortness of breath, arrhythmia, tightening in the chest and heart attack.

Distribution: RegeneSlim is purchased by and distributed through a direct sales force within the United States and Puerto Rico, and through online sales, for both personal consumption and retail sales.

A new TV ad unveiled recently by the conservative group Americans for Prosperity hits U.S. Sen. Mark Udall for the roughly 340,000 health insurance policy cancellations doled out to Coloradans since the implementation of the Affordable Care Act.

What do thousands of cancellations of Coloradan health insurance policies really mean?

The Colorado Division of Insurance has reported that there were about 2,100 health-plan cancellations in the state over the past two months, bringing this year’s total to more than 6,150.

The division reported the figures for June 15-Aug. 15 to Senate Minority Leader Bill Cadman last week. Senate Republicans have requested monthly updates of the numbers. Opponents of Obamacare have used the numbers to make the point that Coloradans continue to lose plans they want to keep.

Since 2013, there have been about 340,000 policy cancellations in Colorado. Many customers received notices last fall as the Affordable Care Act was rolling out. Policies that did not meet the act’s minimum standards were cancelled, though customers were offered replacement policies or early renewals so they could hang on to the non-compliant policies another year or two, until the state and feds finally ended the grace period.

Yet plan cancellations, before and after ACA, are also the result of business decisions by the insurers as part of normal operations. Because cancellation numbers weren’t tracked in the same way prior to the ACA, it’s difficult to compare before and after.

Opponents of the Affordable Care Act cite the cancellations as proof that it is hurting consumers more than helping. Yet the insurance division and the Colorado Association of Health Plans say cancellation figures, without more context, reveal little.

“This doesn’t mean these are people without insurance,” said division spokesman Vince Plymell. “They have a lot more options for insurance under the act.”

Carriers each year decide to drop plans for a number of legal or business reasons, including that they’re not compliant with the law or that they’re no longer popular with enough consumers or profitable for them, Plymell said.

Jaxson Doolin, 6, carries full backpacks to storage Aug. 9 at Element Church in Cheyenne. Volunteers packed 2,000 backpacks full of school supplies for the Back 2 School Bash Saturday at 10 a.m. at Lions Park. Blaine McCartney/staff

In making those back-to-school lists, don’t forget the pediatrician.

Think About It Colorado, a nonprofit consumer awareness group, is advocating that a child have an annual physical exam, even if not required by the child’s school.

Unlike a visit to the doctor for a fever or other acute illness, the annual exam provides more time for physician and family to address any concerns or questions about growth and development.

“As children get older, it’s more important for them to bond with their doctor and feel like they can trust (him or her),” Think About It Colorado said in a statement. “It’s also a good chance for the provider to address important questions, especially with teenagers, including adolescent issues of drinking, smoking, drugs, sexual activity and depression.”

Think About It Colorado advises that, before a visit to the doctor:

1. Compile your child’s medical history, including vaccinations, allergies, health problems and the dates of any surgeries or hospital visits.

2. Update the family history with any changes since the last visit, such as any deaths or serious illnesses of close family members, including brothers, sisters, grandparents, aunts and uncles.

3. Make a list of your child’s medicines and amounts taken, including prescriptions, over-the-counter meds, vitamins, herbs and other supplements.

4. Also keep a running list of any questions you have had about your child’s health in the past year.

U.S. Veterans Administration Deputy Secretary Sloan Gibson, right, and combat veteran Wendy Buckingham salute a color guard during the opening session of the National Order of the Purple Heart National Convention, at which Buckingham serves as Women Veterans Issues Director, in Denver, Tuesday, Aug. 5, 2014. Gibson says more employees will be disciplined as the department sorts out a scandal over long waits for health care and falsified data. (AP Photo/Brennan Linsley)

You’d think it would be a tough crowd.

At the Renaissance Hotel in Denver it’s a sea of purple-clad people, mostly older veterans — the men wearing sharply creased purple and white garrison caps. Medals and insignia almost cover their caps, their lapels. They aren’t in uniforms exactly, but they all wear the same color.

This is the 82nd national convention of the Military Order of the Purple Heart. The Oklahoma man next to me, Frank Casson, says it’s a true hall of heroes tonight. He got his Purple Heart after being blown up by an improvised explosive device in Iraq in 2004.

Gibson hasn’t been at the VA for quite six months. So the current mess isn’t his fault. He served as acting secretary for about two months after Gen. Eric Shinseki was toppled from the post in May by the scandal of ill veterans waiting, sometimes dying, before they could be seen at VA facilities. All the while, administrators falsified waiting times, then reaped performance bonuses for meeting their targets.

“Shinseki was a scapegoat,” Casson said.

Gibson acknowledged the VA was in “the most serious crisis in a generation,” but argued that it presented an extraordinary opportunity to make a compelling case for more resources. He was happy to land in this crisis, he said.

“All I ever wanted was a chance to make a difference,” Gibson said.

But first, he said, the VA had to purge “a corrosive culture of self-protection and retaliation against whistle blowers.”

When he became acting VA secretary, Gibson said, he went to the Phoenix VA hospital, where he met with 75 employees.

“They were often choking back tears,” he said, “about overcoming challenges to care for veterans. What I saw at Phoenix was leadership failure … and chronic under-investment of resources.”

A neurosurgeon there told him that the facility had three X-ray machines, but two weren’t working. Gibson ordered them fixed the next day — a simple fix of updated computer software.

“All it took was for someone to own the issue,” Gibson said.

Gibson has made 14 visits to VA medical centers, including Denver’s on Aug. 6, in the last couple of months.

At San Antonio, Texas, he said, the atmosphere at the VA hospital was one of people brimming with pride in their work and success.

“The irony is the hardest visit for me was San Antonio,” he said. “But for leadership, Phoenix could have looked just like that.”

He promised that the disciplinary actions proposed against six employees involved in scheduling and bonus fraud in Cheyenne and Fort Collins was the first of many such actions.

“A transformation is under way,” he said, “but veterans still wait too long for appointments and the quality of care is not what is should be.”

In talking with family members of people afflicted with the dementia-causing disease Alzheimer’s, the weight of the burden was evident and chilling. But it’s their grace and courage that’s harder to fathom.

“It’s partly a labor of love,” Marcia Walker told me about caring for her husband Frank until he passed away two years ago. “But you do it partly because you don’t have a choice. You do what you have to do.”

Frank, was, by several accounts, a lovely man who made people laugh even after he became affected by the disease in his young 60’s — an early onset. Marcia was 13 years younger.

The early years of the disease were “not completely awful,” she said. “We could still laugh. We could still do things together.”

“One of the helpful things I was told when in the thick of care crises, was that ‘this won’t go on forever.’ I don’t know why that helped me, but it did, I was able to see that what we were going through was hard but it was temporary,” Marcia told me an email of “additional thoughts.”

“The challenges and difficulties changed throughout the course of the disease, but all were temporary. The sad reality is that Alzheimer’s is always a terminal disease,” she wrote.

One of the resources she said she found especially helpful was thealzheimerspouse.com.

“It deals very specifically with the reality of marriage and relationships when caring for a spouse with Alzheimer’s and the isolation it can cause for some people,” she wrote. “I especially liked the message board for posing questions, getting answers from the collective wisdom and experience of others and feeling that you are not alone.”

Here are some of the things she said she learned while caring for her husband over the six years following his diagnosis.

“It takes a village – I welcomed any and all help from neighbors, friends, family, and Senior resource specialists.”

“Gardening became my most satisfying hobby while ‘stuck at home.'”

“I learned so much about compassion and unconditional love with this experience – you don’t stop loving someone even though they are difficult, time-consuming, irritable, irrational and generally challenging. They did not choose to get this disease and have no control over it, and they need your love and protection.”

DENVER, CO. – MARCH 15: A Connect for Health Colorado RV is parked outside Escuela Tlatelolco during a Latino enrollment event in Denver on March 15, 2014 in Denver, CO March 13, 2014. A coalition of groups teamed up to answer questions and offer assistance in healthcare enrollment. (Photo By Craig F. Walker / The Denver Post)

Health policy analysts at the Kaiser Family Foundation recently took a look at how four states, including Colorado, used different approaches to handle the challenges of setting up new health insurance marketplaces within the tight time frame under the Affordable Care Act.

All the state online exchanges and the federal website, HealthCare.gov, faced technological glitches and delays, the foundation found. Despite the challenges, said the report, released July 28, more than 8 million Americans enrolled in new private coverage, and Medicaid coverage grew by 6 million since just before the open enrollment period began in October.

The Kaiser brief highlighted the different approaches taken by four states they deemed success stories in terms of enrollment — Colorado, Connecticut, Kentucky and Washington.

Under the Affordable Care Act, states had the option of defaulting to the federal exchange or creating their own health insurance marketplaces offering health plans and premium tax credits to offset the cost of coverage. The act sought to require all states to expand Medicaid to nearly all adults with incomes at or below 138 percent of the federal poverty level ($27,310 for a family of three in 2014). But then the Supreme Court made Medicaid expansion an option for the states.

All four of the states the foundation looked at built their own exchanges and expanded Medicaid. All four states saw “significant” enrollment, the report states.

All four states used extensive marketing — television, print, radio, billboards and social media — to send “a straightforward message” about the availability of new coverage options, the study found. Among other messages, Connect for Health in Colorado launched a digital billboard that counted down the days left until the end of open enrollment March 31.

The states used a broad array of avenues to reach consumers: libraries, extension centers, grocery and discount stores, barber and beauty shops, college campuses, churches, small businesses, coffee shops, gyms and even people’s homes.

The exchanges used local events, such as fairs and sporting events, to reach large numbers of people. Colorado hosted group enrollment appointments at local schools and libraries. Marketplace staff in Colorado and Kentucky traveled across their states in branded RVs to spread the word. Colorado’s outreach teams spoke with more than 64,000 people in more than 230 locations, the report says.

The states also tried to customize brochures and other materials to reach specific audiences or communities — such as Colorado developing information that focused on the importance of coverage to address special health concerns of African Americans.

They also developed tip sheets and checklists to help people organize all the information they would need when they started their application.

Colorado and Connecticut set up walk-in enrollment sites at office buildings and street malls, among other places. In March, Colorado’s exchange opened five temporary walk-in enrollment sites staffed by Connect for Health Colorado and Medicaid agency staff, insurance brokers and enrollment “assisters.” They reported nearly 3,000 people received help at these sites during the three weeks they were open.

All four states’ exchange stakeholders agreed that one-on-one assistance with trusted individuals was one of the most important factors in getting people enrolled. Several different types of paid and volunteer “assisters” — called navigators in Colorado — supported outreach and enrollment events.

The states also plan to improve and enhance training for the assisters, although there about future funding for assisters.

The Colorado exchange trained and certified more than 1,500 insurance brokers and agents to work alongside the assisters who helped an individual complete the application. The broker would then help the individual choose a plan.

Electa Draper is the health writer for The Denver Post and has covered every news beat in a 22-year journalism career at three newspapers. She has a bachelor's degree in biology and a master's in journalism.